Across Ohio, thousands of individuals with developmental disabilities live meaningful, independent lives in their homes and communities thanks to one essential support system: Medicaid Home and Community-Based Services (HCBS) Waivers.
For families entering the developmental disabilities system, however, Medicaid waivers can feel complicated and overwhelming. Understanding how these waivers work, or how services are evolving across Ohio; can help families make informed decisions about long-term supports and independence.
What is an Ohio Medicaid Waiver?
A Medicaid waiver allows individuals with developmental disabilities to receive services in their home or community instead of living in an institutional setting.
Historically, individuals who required significant support often had limited options outside of institutional care. Waiver programs changed this model by allowing Medicaid funding to “waive” institutional requirements and instead fund community-based supports tailored to each person’s needs.
Today, more than 40,000 Ohioans with developmental disabilities receive services through waiver programs, enabling people to live with family members, roommates or in supported living environments within their communities.
The Three Main Developmental Disability Waivers in Ohio:
The Ohio Department of Developmental Disabilities (DODD) administers three primary waiver programs designed to meet different levels of need.
Individual Options (IO) Waiver:
The Individual Options (IO) Waiver provides the most comprehensive level of support.
This waiver is typically appropriate for individuals who:
- Require significant daily assistance
- Need multiple services
- Have limited natural supports available
Services may include:
- Homemaker personal care (HPC) or supported living
- Adult day services
- Transportation
- Employment supports
- Remote support & Assistive technology
The IO Waiver allows individuals who meet an institutional level of care to remain safely in community settings while receiving individualized services.
Level One Waiver:
The Level One (L1) Waiver supports individuals who need more limited assistance. This waiver works well for people who:
- Live with family members
- Need part-time or intermittent support
- Have strong natural support systems
Because funding levels are capped, Level One waivers are generally designed for individuals requiring fewer paid services while still promoting independence in community living.
SELF Waiver (Self-Empowered Life Funding):
The SELF Waiver emphasizes choice and self-direction. Individuals enrolled in SELF may:
- Hire and manage their own support staff
- Control how services are delivered
- Direct portions of their service budget
While this waiver provides flexibility and independence, it also includes funding caps that require careful long-term planning as needs change over time.
How Do Individuals Receive a Waiver?
Accessing waiver services typically begins with a local County Board of Developmental Disabilities. The general process includes:
- Establishing eligibility for developmental disability services.
- Determining Medicaid eligibility.
- Completing a level-of-care assessment.
- Placement on a waiver waiting list if funding is not immediately available.
- Development of an Individual Service Plan once a waiver slot opens.
Because demand often exceeds available funding, waiting lists remain one of the most significant challenges facing Ohio families today.
Why Medicaid Waivers Matter:
Waivers do far more than fund services. They support quality of life. Through waiver programs, individuals can:
- Live in their own homes
- Participate in community activities
- Maintain employment
- Build social relationships
- Develop independence skills
Ohio’s system reflects a national shift toward person-centered planning, where services adapt to the individual rather than requiring individuals to adapt to institutions.
The Role of Intermediate Care Facilities (ICFs):
While both waiver services and ICFs are funded through Medicaid, they operate under different models of care.
Intermediate Care Facilities provide residential services in structured settings designed for individuals who require a higher level of medical or behavioral support. Unlike waiver programs, which are specifically created to support individuals living in homes and community environments, ICF services are funded as part of Medicaid’s institutional care system.
This distinction is important. Medicaid waivers were developed to give individuals an alternative to institutional care by allowing services to be delivered in community-based settings. As a result, waiver programs such as the Individual Options (IO), Level One, and SELF Waivers focus on promoting independence, choice and community inclusion.
Although waiver funding does not directly pay for ICF services, both programs are supported through Ohio’s broader Medicaid long-term services system. The state balances resources across institutional and community-based supports to ensure individuals can access services that best meet their needs.
In Ohio, Intermediate Care Facilities have historically played an important role in supporting the overall developmental disability system. Funding structures connected to ICF services help sustain statewide investments that also support the continued expansion of home and community-based waiver programs.
Over time, Ohio (like many states) has gradually shifted toward expanding community living opportunities. Today, most individuals receiving developmental disability services do so through waiver programs that allow them to live in homes, apartments or supported living environments within their communities.
However, ICFs continue to serve an important purpose for individuals whose needs require more intensive or specialized supports. Together, institutional services and waiver programs form a continuum of care, ensuring that Ohioans with developmental disabilities have access to safe, appropriate, and person-centered services throughout their lives.
The Future of Developmental Disability Services in Ohio:
As Ohio looks ahead, several major trends are shaping how services will evolve.
Technology and Remote Support Expansion:
One of the most significant developments in recent years has been the growth of assistive technology and remote support services. Technology now allows individuals to:
- Receive overnight monitoring
- Access virtual support staff
- Increase independence while maintaining safety
- Reduce reliance on continuous in-person staffing
Remote support solutions are increasingly recognized as both person-centered and sustainable, especially as workforce shortages continue across healthcare and human services.
Workforce Challenges and Innovation:
Across Ohio, providers face ongoing shortages of Direct Support Professionals (DSPs). This challenge is driving innovation in service delivery, including:
- Flexible staffing models
- Enhanced training programs
- Technology-assisted supports
- Career pathway development for DSP professionals
Future service systems will likely combine human support with smart technology to ensure continuity of care.
Greater Self-Direction and Individual Choice:
Ohio continues to move toward empowering individuals and families to make decisions about their own supports. Programs like the SELF Waiver reflect a broader philosophy emphasizing:
- Personal choice
- Budget control
- Customized services
- Individual independence
This trend is expected to grow as individuals seek services tailored to their lifestyles and goals.
Focus on Independence Across the Lifespan:
Another emerging priority is smoother transitions between life stages, including:
- School-to-adult service transitions
- Employment opportunities
- Aging supports for adults with developmental disabilities
Future systems will increasingly focus on lifelong independence rather than isolated service programs.
Looking Ahead:
Ohio’s developmental disability service system has transformed dramatically over the past several decades. It has shifted from institutional care toward inclusive, community-based living. Medicaid waivers remain the cornerstone of this progress.
As services continue evolving through technology, workforce innovation and person-centered planning. The goal remains clear: helping individuals live safe, independent and fulfilling lives within their communities.
At RMS, we are proud to partner with individuals, families, and county boards across Ohio to support that mission every day.
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